What do you believe is your best course of action for this appointment?
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The patient should remain in the medical care facility until the diagnosis is established and the breathing patterns are restored to prevent future episodes of seizures and breathing troubles. Stabilizing the patient in the medical setting will relieve the currently presented problems and enable to carry out the necessary diagnostic procedures needed to determine the course of treatment. Stabilizing the patient will take two or three steps, depending on the overall condition. First of all, it is crucial to ensure that further seizure episodes do not occur. Some of the medications that can be used to prevent seizures shortly are Levetiracetam and Valproic Acid, which should be administered in the amount and regularity based on the patient’s age and risk for seizures of the patient.
It is also necessary to promote free breathing since it has been obstructed by the inhaling of water into the lungs. In the management of water immersion injury, Cantwell (2016) recommends supplementing 100% oxygen to the patient via an oxygen mask, as well as to monitor blood gas and pulse oxymetry. Regular tests for blood glucose are also required to keep appropriate glycemic levels (Cantwell, 2016). As a result of water damage to the lungs, PEEP may be necessary to improve ventilation patterns in the noncompliant lung (Cantwell, 2016). Diagnostic measures are also needed to differentiate between the likely diagnoses. For instance, chest radiography may show whether damage to the lung has indeed occurred, causing aspiration pneumonia (Swaminathan, 2017). On the other hand, to explore the possibility of newly acquired status epilepticus, it is crucial to determine the focal CNS lesion by performing MRI (Roth, 2016).
What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?
Since one of the possible diagnoses, in this case, is epilepsy, it is crucial to review the medical history of the patient to establish the state of his nervous system and determine required diagnostic measures (Burns, Dunn, Brady, Starr, & Blosser, 2016). Historical findings indicating the possibility of epilepsy include underlying medical diagnoses, such as diabetes, renal disease, and cardiovascular disorders, previous CNS infection, intrauterine infection or trauma, recent head injuries, family history of seizures (Burns et al., 2016). Clinical findings that would indicate the need for further diagnostics of epilepsy include abnormal EEG (Burns et al., 2016). MRI would help to confirm the diagnosis of epilepsy as it would determine the existence and location of the focal CNS lesion (Roth, 2016). In the case of aspiration pneumonia, however, particular attention should be paid to the physical exam of the patient’s breathing to identify any abnormal noise in the lungs (Swaminathan, 2017). Chest radiography would be used to support the diagnosis as it would show any pathological changes in lung structure and indicate remaining liquid or damage to the lung (Swaminathan, 2017).
What would be three differentials in this case?
There are three main differential diagnoses in the present case. First, seizures may indicate a newly-acquired status epilepticus. Secondly, it is highly possible that the patient developed aspiration pneumonia due to the inhaling of liquid from the swimming pool. The patient’s symptoms, including a persistent cough, tachypnea, hypoxia, and tachycardia, support this suggestion (Swaminathan, 2017). The third differential diagnosis is a generalized seizure. Given the patient’s history of tonic-clonic seizures, absence seizures, and frequent myoclonus, it is possible to suggest that the incident was not caused by any new condition.
Burns, C., Dunn, A., Brady, M., Starr, N. B., & Blosser, C. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier Saunders.
Cantwell, G. P. (2016). Drowning treatment & management. Medscape. Web.
Roth, J. L. (2016). Status epilepticus overview. Medscape. Web.
Swaminathan, A. (2017). Aspiration pneumonitis and pneumonia. Medscape. Web.